"It was all legality," Porten said. "Everybody was protecting their own liability instead of thinking of me."
Administrators at Capital OB/GYN declined to comment. Gary Zavoral, a spokesman for Sutter Health, which runs the emergency room where Porten was taken, said once a patient arrives in the ER for assessment, hospital staff must follow strict protocols.
"The process is to make sure everybody is safe: the individual's safe, the family's safe, the staff is safe," he said. "The process does take some hours, so 10 hours is not unusual."
When patients reference violent thoughts, it forces doctors to think about things in a different way, said Dr. Melanie Thomas, a psychiatrist at the University of California, San Francisco and Zuckerberg San Francisco General Hospital.
California law allows doctors to involuntarily confine a person with a mental disorder if they are a danger to themselves or others. But Thomas said what constitutes imminent danger can be vague.
"You can imagine a provider, a social worker, any number of people might interpret that phrase in different ways, about what is necessary to report and what isn't," she said.
The laws and medical protocols don't always line up, Thomas said. There have been times she felt asked to rely on legal reasoning over her clinical judgment.
"The fragmented aspects of our system of care make it difficult to get women the help that they really want," Thomas said.
That's one reason lawmakers in Sacramento are introducing a package of bills to specifically address maternal mental health. Assemblyman Brian Maienschein, R-San Diego, backs two of them. One would require doctors to screen new moms for depression -- under current law in California, it's voluntary.
"The numbers here are so significant that I think it's something that doctors really should understand and should be prepared to both diagnose and treat," he said. Screening, he added, also "educates a woman in that situation that this is an issue that may impact her."